Wyn T, Jones J, McNinch D, Heacox R
Michigan State University, Grand Rapids, USA.
Acad Emerg Med. 1995 Nov;2(11):979-82. doi: 10.1111/j.1553-2712.1995.tb03125.x.
To determine the sensitivity and specificity of portable fluoroscopy for foreign-body detection using an ex-vivo experimental model.
A prospective, randomized masked investigation was performed to characterize foreign-body detection in cubes of beef. Three emergency physicians (EPs) independently used a portable fluoroscope to determine the presence or absence of various foreign bodies in ten cubes of beef (approximately 6 cm on each side). Six different groups of foreign bodies were examined: glass, wood, graphite (pencil lead), metal (needle), plastic, and gravel. An independent observer placed the six objects randomly into each set of ten beef cubes. One hundred observations were made by each physician using sets of ten beef cubes at a time.
Fluoroscopy detected 117 of 180 foreign bodies (sensitivity 65%; 95% CI 58-72%), including all cubes of beef embedded with gravel, metal, and glass. Graphite was detected 27 of 30 times (sensitivity 90%; 95% CI 74-98%). None of the plastic or wooden foreign bodies was identified despite magnification techniques and real-time imaging (sensitivity 0%; 95% CI0-12%, each). Of the 120 cubes of meat with no foreign body, two false-positives were recorded (specificity 98%; 95% CI 94-100%). The overall positive predictive value and negative predictive value of fluoroscopy were 98% and 65%, with 95% CIs of 94-100% and 58-72%, respectively. Interobserver agreement between the three EPs was considered excellent (kappa = 0.75).
Bedside fluoroscopy lacks sufficient sensitivity to rule out many foreign bodies in the ED. Its use should be limited to suspected gravel, glass, pencil lead, and metallic objects, which are known to be radiopaque.
使用体外实验模型确定便携式荧光透视检查在异物检测中的敏感性和特异性。
进行了一项前瞻性、随机双盲研究，以确定牛肉块中异物的检测情况。三名急诊医生独立使用便携式荧光透视仪，判断十个牛肉块（每边约6厘米）中是否存在各种异物。共检查了六组不同的异物：玻璃、木头、石墨（铅笔芯）、金属（针）、塑料和砾石。一名独立观察者将这六种物品随机放入每组十个牛肉块中。每位医生每次使用十个牛肉块进行一百次观察。
荧光透视检查在180个异物中检测出117个（敏感性65%；95%可信区间58 - 72%），包括所有嵌入砾石、金属和玻璃的牛肉块。石墨在30次检测中被检测出27次（敏感性90%；95%可信区间74 - 98%）。尽管使用了放大技术和实时成像，但未检测出任何塑料或木质异物（敏感性均为0%；95%可信区间0 - 12%）。在120个没有异物的肉块中，记录到两例假阳性（特异性98%；95%可信区间94 - 100%）。荧光透视检查的总体阳性预测值和阴性预测值分别为98%和65%，95%可信区间分别为94 - 100%和58 - 72%。三位急诊医生之间的观察者间一致性被认为极佳（kappa = 0.75）。
床边荧光透视检查缺乏足够的敏感性来排除急诊科中的许多异物。其应用应限于怀疑有砾石、玻璃、铅笔芯和金属物体的情况，因为已知这些物体是不透射线的。
